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By Nancy Thorner & Ed Ingold -
Knowledge of the situation is evolving quickly. While there is a lot of good information (even from Dr. Oz), there is a lot of misinformation too, out of ignorance and for political gain. The Democrats are saying “Testing, Testing, Testing”, not because it is effective but because there is a shortfall of test kits, and more important, labs and technicians to perform those tests. In other words, something they can blame the administration for. As I have noted before, politicians don’t solve problems, they exploit them. Politicians tend to be good talkers, and extraordinarily poor listeners in these circumstances.
An epidemic is like a chain reaction. COVID-19 is mainly spread person-to-person, secondarily through contaminated surfaces and possibly airborne particulate. By current estimates, each person can pass the disease to an approximately 2.5 other persons through normal social contacts. This is, in effect, the definition of a chain reaction. If controlled, as in a nuclear reactor, it provides heat and power. If uncontrolled, it explodes like a nuclear weapon. Using the nuclear analogy, the same amount of fuel provides the same amount of energy, over weeks, months or years, or in microseconds
The difference is the intensity In the case of an epidemic, people are the “fuel” and the number of people they give it to are the “neutrons”. This constitutes a geometric progression, and any factor greater than one creates a chain reaction which quickly gets out of hand. The reaction slows down as there are fewer people susceptible to infection, or when the infected person has fewer contacts with others.
According to the “Herd Theory,” once about 60% of the acquire immunity, either from surviving or through vaccination, the epidemic ends, slows or becomes endemic, like common colds and seasonal influenza.
What are the best ways to keep an epidemic from “exploding,” and overwhelming our ability to treat and save those who have life-threatening consequences?
- Vaccination
Grants a high degree of immunity against becoming infected and transmitting the disease to others. People don’t get sick, and don’t make others sick. - Anti-Viral Drugs A number of drugs may reduce or shorten the course of infection. The most promising of which are monoclonal antibodies, which mimic the effect of natural antibodies produced by the body in reaction to the infection or vaccination. They attack and destroy the virus before it can cause more harm.
- Limiting Social Contact
Of the measures which can be done now, this is probably the most effective way to reduce the number of infections passed on to others. If that ratio is one or less, it’s no longer an epidemic. Self or government quarantine measures work. If you know you’re sick, stay home! Because an epidemic is a geometric progression, reducing opportunities to communicate the disease are especially effective. - Personal Hygiene and Preventive Measures These measures include hand washing, covering coughs and sneezes and wiping surfaces you might touch.
- Limiting External Sources – Limiting entry to the US of individuals possibly exposed to the disease is somewhat less effective. The severity can be compounded if bottle necks cause large numbers of people to remain in close contact. Keeping them on cruise ships or in quarantine areas in airports is highly counter-productive. At best, the efficacy of these efforts is only proportional to the number of infected persons excluded.
- Testing – Diagnostic testing is vital to establishing parameters related to the extent and consequences of the disease. However it does not cure, treat or prevent the disease (other than coincidentally). Patients who test positive should take all measures to avoid spreading it to others and be alert to any changes which would require hospitalization, preferably by phone with your physician. There is no worse place to be than in a waiting room or emergency clinic, because that’s where the sick people are. Testing negative is of much less value. Although you don’t have the disease now, you could catch it within hours, days or weeks. Statistically, the majority of people tested at will be free of the disease, asymptomatic, or exhibiting symptoms of varying degrees. The number of people actually hospitalized or dying from the disease won’t change, but the probability of grave effects will allow experts and the government to manage resources better.
Unreliability of News Media
The news media is very unpredictable, because drama promotes listenership. Rather than sticking to simple facts, like temperature, they report “wind chill” in the winter and “heat index” in the summer. Both are fuzzy facts, because chill depends on wind velocity (which varies widely within minutes or seconds), and the latter on both humidity and wind. For coronavirus, they report cumulative data, because the number is large and just keeps growing. In fact, 90% of the victims have already recovered, so out of “100,000” cases, only about 10,000 are still active.
In the last week alone, President Trump has worked with scientists, government agencies, state and local officials to produce the following results.
- Millions of virus test kits have been distributed
- The CDC no longer insists on performing the testing. The can now be done in state and local labs, as well as private labs.
- The FDA expedited approval of faster tests (3-4 hours instead of 3-4 days)
- The FDA approved initial tests of coronavirus vaccines on healthy human volunteers
- Drive-through testing facilities are now in operation, speeding data collection and protecting both citizens and health care workers
- A policy of “social separation” has been instituted, without resorting to quarantines and curfews
- FEMA and the Corps of Engineers have been authorized to construct mobile intensive care facilities, popularized on M.A.S.H 30 years ago.
- The expressed goal is “15 Days and Out”, because these measures are expected to bring severe cases to a level within the capacity of ICU facilities.
On the other side, there is a lot of talk and hand-waving. Pelosi could use Harry Potter’s wand, if that’s all it took to get something done.
Facts about the Coronavirus
One thing is clear, we are not going to “stop” the disease nor eliminate it this year. At best, we can slow it to the point our infrastructure can handle its worst manifestations. What will halt the epidemic is when enough of the population (60-80%) gains immunity either through vaccination or recovery. If we keep schools and businesses closed beyond the manageable level of acute symptoms, our economy will suffer unnecessarily, perhaps beyond the point of recovery.
This chart highlight problems with interpretation of the data. The number of “New Cases” increased dramatically in mid-March, but the number of tests which were administered nearly doubled because regulations on testing were relaxed on March 9th. This explains the spike in testing, but are the tests being administered at random. They are more likely given to people who think they are ill and probably are.
Unlike the course of an epidemic, the total number of cases never goes down. Since that is all we see on the news, other than a cartoon version of the curve, the crisis will never end. Government control wins, and we lose. And the justification for a curfew is … because they can.
The graph below was prepared by Ed Ingold using Microsoft Excel from data from the CDC regarding non-repatriated cases, which means people coming from other countries with the disease are not counted.
The percentage of tests reading positive hovered between 5% and 10% from the 9th until the 14th, when they jumped to 14.5% and 17.7%.
The reporting, however, is incomplete, as it also distorts the results. Based on available data, the mortality rate is 1.7% but the number of mild cases is probably under-reported, which, if counted, would decrease the mortality rate. Deaths have disproportionately occurred among the elderly and infirm, especially in two nursing homes, Kirkland, WA and DuPage County, IL.
All this highlights the need for better data in order to track the progress and predict the future of the COVID-19 epidemic. Lack of population data does not have much effect on the number of patients requiring intensive care, minus those who recover and leave ICU, or die. As of March 17, there are far fewer patients requiring ICU (est. 800-1000, or about 20% of active cases) than there are available ICU beds (~34,000).
Vital statistics about the COVID-19 epidemic are hard to find and generally of low quality. The data is strongly biased in the pessimistic direction. Most of the deaths occurred among elderly people with compromised general health (i.e., nursing homes), who are also clustered in close contact with the staff and each other. Most of the tests have been performed on people who have or suspect they have symptoms of the virus.
Assault on nation's economy?
There is a fallacy in letting scientists and doctors set the requirements. There must be a balance between safety and economic impact of these choices. There are still internecine rivalries between government agencies getting in the way of both. In simple terms, every decision must be based on a cost vs benefit basis. In short, it takes politics to make things happen in the right way. It goes down to the individual level too. What does it help to survive the infection only to be ruined financially? Even Bloomberg’s Billions can’t solve that equation.
Out of abundance of caution, scientists and physicians on the president’s COVID team are calling for ever more draconian limits on assembly and movement. This must be balanced against economic consequences, not to mention constitutional freedoms. There are no 100% guarantees in life.
We desperately need unbiased data, where people are tested based on a completely random basis, much like a Gallup Poll, and at regular intervals. That is the only way to determine the true extent and progress of the epidemic, to fill in the blank spaces in the SIR model, and to evaluate the effectiveness of current measures. Statistically, this could involve as few as 1000 people and yet yield good accuracy. Since transmission of COVID-19 is relatively simple, mathematical models of the epidemic are useful, given accurate data.
There is no better way to ease the anxiety of the public than to tell the truth, however unpleasant. Secondly, people will accept the hardships imposed on them if they know what the goals are, and at what point the restrictions will be lifted.
COVID-19 will probably not be eliminated in our lifetime, but it can be reduced to a tolerable level so that commerce can resume. In the real world, good enough is usually good enough.
Anything is better than crowds with pitchforks and torches.
Check out Fact Checking on Covid-19 and Leftist Schadenfreude by Thorner and Ingold, Monday, March 16 2020. https://www.illinoisreview.com/illinoisreview/2020/03/thorneringold-fact-checking-on-covid-19-and-leftist-schadenfreude.html
